The BKPA is disappointed that for a third year running we appear to have made little progress in improving tariff to improve patient-centred care. We are working with NHS Improvement and NHS England on the renal dialysis and transplant tariffs as stakeholders but this work is not at all complete. Indeed NHS Improvement’s own audit on the quality of data provided into costings returns makes it clear that most trusts (86% of them) are not supplying ‘compliant’ data. With regard to renal care, you have previously stated that “Tariffs for renal dialysis calculated using reference costs do not cover the cost of treatment.”
We welcomed the opportunity to comment on some draft costings in the summer of 2016 but we are now dismayed by the proposals, which represent a greater reduction than anticipated and appear to go against suggestions of innovation and encouragement for therapies such as home dialysis, which can offer greater quality of life, flexibility in treatment times and reduce the reliance on patient transport services. For us, the choice of all therapies for patients is a central plank of patient-centred care and it is not clear why the tariff for home haemodialysis and peritoneal dialysis is reduced further than anticipated relative to other treatment.
While we welcome the principle of stability for treatment costs the quality of kidney care cannot be maintained by the constant erosion of funding. Best practice tariffs for renal are generally reduced by an average of 4%. Every year since best practice tariffs have been in place there has been a reduction in tariff for dialysis services, as the diagram below shows. We would prefer that you retain the current tariff while accurate costs are established, rather than introduce the proposals outlined in your consultation.
We see that a 40% reduction in tariff for follow up multi professional outpatient clinics is proposed. Care for the patient with or approaching kidney failure is not simply dialysis - it may be transplantation or conservative care (active management for those who choose not to dialyse, with the UK as a world leader). It must be delivered regularly by a multi-professional team which looks after the individual. The team will work with the patient to share treatment decisions. Clinics may involve education, pharmacy, dietary, rehabilitation, psychological advice and other services. Multi-professional teams are at the heart of kidney care and any cost reductions should be proportionate. We do not support this proposal. The BKPA itself funds about 60 multi-professional staff in the NHS, which gives us a strong insight into the enormous value of good multi-professional support for kidney patients to maintain some quality of life.
Tariff figures 2014-2018